In our qualitative longitudinal study we conducted interviews with 15 couples recruited from the Copenhagen Pregnancy Loss Cohort to investigate their experience and needs for medical care and support across the three trimesters of pregnancy. Interviews were conducted with couples together after the first pregnancy test and once in each trimester. Our thematic analysis showed that for couples there were two phases of pregnancy: the first 20 weeks with a “scary” gap in pregnancy care, and the second 20 weeks with a sense of safety in the existing antenatal program. These findings highlighted a gap in the care needs in the first half of pregnancy when couples were particularly anxious, worried and distressed about experiencing another PL and had less access to standardized care. Findings showed that both partners expressed a high degree of worry and anxiety about the pregnancy, particularly in the early months. Partners wished to be more involved in care and to receive information about how to support their partner and to cope with their own worries. The findings challenge the assumption that because PL is common, couples should “just try again” which minimizes the psychological and physical impact of this event.
In the intervention development phase of the project, we used a three-stage to co-produce and prototype test an intervention with stakeholders and patients. We created a stakeholder group of multidisciplinary experts to consult on the development of the intervention. Two focus groups were held with patients (women and partners) for input into the content of the intervention and to provide feedback on the early prototype. Finally, an online survey was developed to assess patient views on the acceptability of the intervention. The focus group and online survey data showed that the intervention was acceptable, useful and relevant. Patient feedback was integrated into the final versions of the intervention. For example, we developed a separate tool for women and for partners to meet their unique needs. The intervention is available online and paper format and is being integrated into care provided at Hvidovre Hospital through the Copenhagen Pregnancy Loss research project. A manuscript on this process is forthcoming.
PREGAFTERPL findings have been presented at the European Society of Human Reproduction and Embryology, The Nordic Fertility Society, The European Preconception Health and Care conference. Two conference presentations are upcoming at the European Public Health conference 2024. Our first open access article is: Koert E et al. (2023). 'You're never pregnant in the same way again': prior early pregnancy loss influences need for health care and support in subsequent pregnancy. Human Reproduction Open. 2023(3):hoad032.
Workshops for clinicians have been provided at the Danish Fertility Society and Midwives Association annual meetings. An educational video is available online and will be distributed to the Danish Society of Obstetrics and Gynecologists.
Our exploitation strategies included presenting the findings to health care professionals, community stakeholders and general public and providing patient information workshops. The information tools can be integrated into a larger web-based tool for PL support planned by the Copenhagen Pregnancy Loss research group. We plan a grant application to test the feasibility, implementation and evaluation of the information tool intervention into an early pregnancy unit setting.
